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Teriflunomide is a medication that carries several important safety warnings. It is crucial to understand the potential risks and necessary precautions before using this drug. Below are key points to consider:

• Pregnancy Risks: Teriflunomide can cause significant harm to an unborn baby, including birth defects or stillbirth. Women of childbearing potential must have a negative pregnancy test prior to starting treatment and must use reliable contraception throughout the treatment and for a period after stopping. Men are also advised to use effective birth control to prevent pregnancy. If pregnancy occurs, contact your healthcare provider immediately.

• Liver Health: This medication can cause serious liver damage. Individuals with pre-existing liver conditions or those taking other liver-affecting medications are at an increased risk. Regular liver function tests will be conducted before and during treatment. Symptoms such as persistent nausea, vomiting, loss of appetite, dark urine, or yellowing of the skin and eyes should be reported to your doctor without delay.

• Drug Elimination: Teriflunomide is eliminated from the body slowly, which may take up to 2 years. If rapid removal is necessary, such as when planning a pregnancy or experiencing intolerable side effects, medications like cholestyramine may be used to expedite this process.

• Infection Risk: Teriflunomide may weaken the immune system, heightening the risk of serious infections. This risk is particularly significant for those on other immunosuppressive drugs. Ensure you are up-to-date with vaccinations before starting treatment, but avoid live vaccines during medication use.

• Allergic Reactions and Skin Conditions: Severe allergic reactions, including anaphylaxis and DRESS, have been reported. Serious skin reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis may occur. Seek immediate medical attention if you experience symptoms such as rashes, fever, or blistering skin.

• Nerve Issues: Some patients have developed peripheral neuropathy, resulting in numbness or tingling in extremities. If these symptoms arise, inform your healthcare provider, as discontinuation and rapid elimination of the drug may be necessary.

• Lung Complications: Rare cases of interstitial lung disease (ILD) have been associated with teriflunomide. Symptoms such as coughing or difficulty breathing require prompt medical evaluation.

• Use Restrictions: Avoid using teriflunomide if you have severe liver problems, are pregnant, do not use birth control (if you can become pregnant), or have allergies to leflunomide or teriflunomide. It should not be used simultaneously with leflunomide (Arava).

In case of an overdose or any severe adverse reactions, immediate medical intervention is essential. Always consult your healthcare provider for personalized guidance and clarification on any concerns related to teriflunomide treatment.

Common side effects:

• diarrhea
• nausea
• sensations like tingling, burning, or numbness on the skin
• temporary hair loss
• headaches
• abnormal liver test results

Serious side effects:

• signs of liver problems (nausea, vomiting, stomach pain, yellowing of the skin or eyes, pale stools)
• symptoms of infections (persistent sore throat, fever, cough, swollen lymph nodes)
• high blood pressure
• allergic reactions (rash, itching or swelling, severe dizziness, difficulty breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• leflunomide

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• ketorolac
• tovorafenib
• vorasidenib